Functional prognosis according to therapeutic window in patients with acute ischemic stroke treated with IV thrombolysis in Latin American hospitals

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AIM: To describe outcomes among treated patients with thrombolysis and compare associations across three therapeutic-window periods in acute ischemic stroke. METHODS: We conducted a subanalysis of the FAICAM registry, a retrospective multicenter cohort from 2022, including patients ≥18 years with acute ischemic stroke treated with intravenous alteplase within or beyond the standard therapeutic window. Patients with baseline Modified Rankin Scale (mRS) of >2 or those who underwent thrombectomy were excluded. Bivariate and multivariate analyses were performed for therapeutic windows of ≤3, 3-4.5, and >4.5 hours RESULTS: We analyzed 355 patients; 283 of whom had 3-month mRS data. Functional independence was 82.0% in group treated within first 3 hours, 68.9% (between 3 and 4.5 hours), and 58.6% (after 4.5 hours) at 3 months. In the multivariate analysis, patients treated between 3 and 4.5 (aRR: 0.83; 95% CI: 0.72-0.96; p = 0.011) and >4.5 hours (aRR: 0.71; 95% CI: 0.56-0.90; p = 0.005) were associated with a lower probability of functional independence versus ≤3 hours.at 3 months CONCLUSIONS: In this real-world cohort of patients treated with intravenous alteplase in Latin American hospitals, treatment closer to symptom onset was associated with a higher probability of functional independence at 3 months; because this study did not include an untreated comparison group, it cannot establish the efficacy of thrombolysis itself. These findings underscore the importance of standardizing selection criteria and hospital protocols to improve safety monitoring for patients treated within the extended window.

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